Pelvic Inflammatory Disease (PID): Symptoms, Causes and When to Seek Help

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Pelvic inflammatory disease (PID) is an infection and inflammation of the upper reproductive organs, including the uterus, fallopian tubes and ovaries. It can cause pelvic pain, unusual vaginal discharge or bleeding, but some people experience only mild symptoms or none they recognise.

Because the symptoms can overlap with period pain and other pelvic health concerns, PID isn't always easy to identify. Prompt medical assessment and antibiotic treatment are important because untreated infection can sometimes affect long-term reproductive health.

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What is pelvic inflammatory disease?

Pelvic inflammatory disease, usually shortened to PID, occurs when bacteria spread from the vagina or cervix into the upper reproductive tract. The infection can affect the lining of the uterus, fallopian tubes, ovaries and surrounding pelvic tissues.

PID can affect anyone with these reproductive organs, although it is most often diagnosed in sexually active people of reproductive age. Symptoms vary considerably. Some people become unwell quite quickly, while others have subtle symptoms that are easy to overlook.

Understanding your reproductive anatomy can help make sense of where PID occurs and why early treatment matters.

What causes PID?

PID develops when bacteria reach the upper reproductive tract. Sexually transmitted infections (STIs), particularly chlamydia and gonorrhoea, are important causes, but they aren't the only ones. Mycoplasma genitalium and bacteria that normally occur in the vagina, including some associated with bacterial vaginosis, can also be involved.

Factors associated with an increased risk of PID include:

  • Having an untreated STI, particularly chlamydia or gonorrhoea
  • Having sex without condoms or other barrier protection, especially with new or multiple partners
  • Having had PID before
  • Recent procedures involving the cervix or uterus, although PID following these procedures is uncommon

Vaginal douching may also increase the risk of PID. The vagina doesn't need internal washing, and douching can disrupt its usual bacterial environment.

Having PID doesn't necessarily mean you or your partner has a diagnosed STI. A healthcare professional can help investigate the possible cause without judgement.

What are the symptoms of PID?

PID symptoms range from mild discomfort to more severe illness. Some people have no obvious symptoms, which is one reason infections may go unnoticed.

Possible symptoms include:

  • Lower abdominal or pelvic pain, sometimes on both sides
  • Unusual vaginal discharge, including a change in colour, amount or smell
  • Bleeding between periods or after sex
  • Heavier or more painful periods than usual
  • Pain during sex, particularly with deep penetration
  • Pain or discomfort when urinating
  • Fever, chills, nausea or feeling generally unwell

These symptoms can have several causes and don't necessarily mean you have PID. However, new, persistent or unexplained pelvic pain, unusual bleeding or changes in discharge deserve medical assessment.

Can PID feel like period pain?

Yes. PID can cause lower abdominal cramping or aching that feels similar to menstrual cramps. It can also be associated with heavier or more painful periods, which may make the symptoms harder to distinguish from your usual cycle.

Period pain typically occurs around the start of menstruation and follows a recognisable pattern for many people. Pain related to PID may occur at other times in your cycle, continue between periods or come with symptoms such as unusual discharge, bleeding after sex or fever. These patterns aren't reliable enough to diagnose PID on their own.

If pelvic pain is new, getting worse, lasting longer than usual or accompanied by other symptoms, don't assume it's simply part of your period. A GP or sexual health clinician can investigate what's causing it.

How is PID diagnosed?

There isn't a single test that can confirm or rule out every case of PID. A healthcare professional will consider your symptoms, medical and sexual history and examination findings, and may recommend tests to investigate possible infections or other causes of pelvic pain.

Depending on your circumstances, assessment may include:

  • A pelvic or abdominal examination
  • Urine tests or vaginal or cervical swabs to check for STIs
  • A pregnancy test, where relevant
  • Blood tests or a pelvic ultrasound to investigate other possible causes or complications

An ultrasound can sometimes identify complications, but a normal scan doesn't rule out PID. If PID is suspected, a clinician may recommend beginning treatment before test results are available.

How is PID treated?

PID is treated with prescription antibiotics, usually a combination chosen to cover the bacteria that may be responsible. Mild to moderate infections can often be treated outside hospital. More serious infections may require hospital care and intravenous antibiotics.

If you're diagnosed with PID, it's important to:

  • Take your antibiotics exactly as prescribed and complete the course
  • Attend follow-up, usually within 48โ€“72 hours, so your clinician can check that treatment is working
  • Avoid sexual intercourse until treatment is complete, symptoms have resolved and relevant partners have been treated, following your clinician's advice
  • Ensure sexual partners are assessed and treated when recommended to reduce the risk of reinfection

If symptoms aren't improving within 48โ€“72 hours, seek reassessment promptly. Antibiotics treat the infection, but they cannot reverse scarring that has already developed.

Can PID cause long-term complications?

Many people recover well with treatment. However, PID can sometimes cause inflammation and scarring, particularly in the fallopian tubes. Possible complications include:

  • Ongoing or recurring pelvic pain
  • Difficulty becoming pregnant due to damage to the fallopian tubes
  • An increased risk of ectopic pregnancy, where a pregnancy develops outside the uterus
  • A tubo-ovarian abscess, which is a collection of infection involving a fallopian tube or ovary

Not everyone with PID experiences these complications. Seeking care early can reduce the risk, which is why unusual symptoms shouldn't be ignored.

Can PID be prevented?

Not every case of PID can be prevented, but there are practical ways to reduce the risk of infections that can lead to it:

  • Use condoms and other appropriate barriers to reduce STI transmission
  • Have STI screening as recommended for your circumstances, particularly with a new partner
  • Seek testing and treatment promptly if you or a partner may have an STI
  • Avoid vaginal douching and unnecessary internal cleansing
  • Follow advice about STI screening before relevant reproductive health procedures

Routine STI screening can be valuable even when you feel well, because infections such as chlamydia may not cause noticeable symptoms.

When should you seek medical help?

Book a prompt appointment with a GP or sexual health clinic if you have unexplained lower abdominal pain, unusual discharge, bleeding between periods or after sex, pain during sex or possible exposure to an STI. You don't need to wait until symptoms become severe.

Seek urgent medical assessment for severe or rapidly worsening pelvic pain, high fever, repeated vomiting, fainting or significant illness. If pregnancy is possible and you have pelvic pain or bleeding, urgent assessment is particularly important because an ectopic pregnancy must be considered.

In Australia, you can contact healthdirect for health advice or speak with your GP or a local sexual health service. Call 000 for a medical emergency.

Frequently asked questions about PID

Can you have PID without an STI?

Yes. Although chlamydia and gonorrhoea are important causes of PID, other bacteria, including bacteria associated with bacterial vaginosis, can also contribute. A clinician can assess your symptoms and recommend appropriate tests.

Can PID go away on its own?

Symptoms may become less noticeable, but that doesn't mean an infection has cleared or that complications cannot develop. Suspected PID needs medical assessment and usually antibiotic treatment rather than waiting to see whether it settles.

Can PID affect your period?

Yes. PID may be associated with heavier or more painful periods and bleeding between periods. These changes can also happen for other reasons, so it's important to have unusual or persistent bleeding assessed.

Can menstrual cups or discs cause PID?

PID is generally caused by bacteria spreading into the upper reproductive tract, commonly in association with an STI. There isn't established evidence that correctly used menstrual cups or discs are a common cause of PID. Follow the manufacturer's cleaning, handling and wear-time instructions, and seek medical advice if you develop symptoms of infection.

Can you get PID more than once?

Yes. PID can recur, particularly if an infection isn't adequately treated or a new infection occurs. Completing treatment, attending follow-up and ensuring relevant partners are assessed can help reduce the risk.

Does PID always cause infertility?

No. Many people who have had PID can become pregnant. However, inflammation and scarring can affect the fallopian tubes and increase the risk of fertility difficulties or ectopic pregnancy. Early treatment helps reduce these risks.

Understanding changes in your pelvic health

It's useful to know what's typical for your body, including your usual period pain, bleeding pattern and vaginal discharge. Changes don't always signal something serious, but new or persistent symptoms are worth discussing with a healthcare professional.

At Period Shop, we believe clear, practical information can help you understand your body and make confident decisions about your care. You can explore our guides to reproductive anatomy, vaginal discharge and pain during sex for further reading.

Sources and further reading

This article is for general education and is not a substitute for individual medical advice, diagnosis or treatment.